Evolving self view and body image concerns in female postoperative bariatric surgery patients

To explore the experience of postoperative bariatric surgery patients as they adjust to diminished weight and differentiate that adjustment from the more general concept of body image.

Bariatric surgery is an effective way to reduce weight and comorbidities associated with obesity. Complete success requires that patients must adjust psychologically as they lose weight. If this does not occur, bariatric patients may experience a "mind-body lag," in which the patient's internal body image lags behind the external changes. Hermans' Dialogical Self Theory of "I-positions" is a foundation with which to understand this problem.

Descriptive correlational study of postoperative bariatric patients explored the concept of "I-obese" and "I-ex-obese" in an effort to quantify previous qualitative findings and develop a survey questionnaire.

Bariatric patients (N = 55) between 18-30 months postoperative completed one-hour interviews. Cluster analysis and chi-squared analysis compared mean scores and explored the prevalence of "I-positions" and body image concerns in the participants.

Cluster analysis of the survey data identified participants as falling into either "I-obese," "I-ex-obese" or "mixed I-obese" categories. There were significantly higher body image concerns in the "I-obese" participants than those identified as "I-ex-obese." The majority of female participants reported high body image concerns. There was no significant association with weight loss percentage.

This research establishes a connection in this study sample of women who experience body image concerns and prolonged "I-obese" identification 18-30 months after their bariatric surgery.

To date, the primary measure of bariatric surgery success has focused almost exclusively on the amount of weight loss. Implementing psychological as well as physiological care, however, may be the key to full recovery and long-term success. Practitioners can use this new information to plan effective pre- and postoperative psychological preparation and support.